CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

935 Food Insecurity Is AssociatedWith HIV Serostatus and Sexually Transmitted Infections Kartika Palar 1 ; Barbara Laraia 2 ; Alexander C.Tsai 3 ; Mallory Johnson 1 ; SheriWeiser 1 1 Univ of California San Francisco, San Francisco, CA, USA; 2 Univ of California Berkeley, Berkeley, CA, USA; 3 Massachusetts General Hosp, Boston, MA, USA

Background: Food insecurity is associated with HIV risk behavior in multiple studies, suggesting a link to HIV acquisition. Yet no population-level studies have examined the association between food insecurity, HIV risk factors, and prevalent HIV among men, the group representing the majority of HIV diagnoses in the United States. We hypothesized that food insecurity would be associated with HIV seropositivity and increased prevalence of HIV risk factors including STIs and illicit drug use in this population. Methods: We conducted cross-sectional analyses using 14 years of data from the National Health and Nutrition Examination Survey (NHANES) 1999-2012, a nationally representative survey of the civilian non-institutionalized population of the United States. Household food security was measured using the validated 18-item Household Food Security Survey module. The primary outcome was HIV serostatus. Secondary outcomes were measures of HIV risk, including herpes simplex virus 2 (HSV-2) serostatus, self- reported STIs (genital warts, gonorrhea or chlamydia), and recent illicit drug use. HIV and HSV-2 serostatus were based on blood tests conducted as part of NHANES. Analyses were adjusted for age, race/ethnicity, relationship status, household size, poverty-income ratio, education, smoking, and heavy drinking, and utilized appropriate design weights and complex survey commands to estimate nationally-representative associations. Results: We analyzed data for 9150 men representing 61 million individuals in the US. Unadjusted prevalence of HIV was 1.5% among food insecure men, compared to 0.4% among food secure men (p<0.001). In adjusted models, food insecure men had over 2 times higher odds of HIV infection compared to food secure men (adjusted odds ratio (AOR)=2.09; 95% CI 1.05-4.13; p<0.05). Food insecurity was also significantly associated with 1.29 higher adjusted odds of HSV-2 seropositivity (95% CI 1.05 - 1.59; p<0.05), 1.55 higher adjusted odds of self-reported STIs (95% CI 1.08 - 2.21; p<0.05), and 1.63 higher adjusted odds of illicit drug use (95% CI 1.19 - 2.24; p<0.01). Results were robust to sensitivity analyses restricting analyses to lower income men. Conclusions: Food insecurity is associated with prevalent HIV, STIs and illicit drug use among men in the United States, and should be addressed as part of structural approaches to HIV prevention among men. Further research is needed to establish whether and through what mechanisms improved food security may help prevent new HIV infections.

Poster Abstracts

936 Impact of Male Partners and Schooling on HIV Risk Among South African Girls: HPTN 068

Audrey Pettifor 1 ; JingWang 2 ; Amanda Selin 1 ; James P. Hughes 3 ; Catherine MacPhail 4 ; Xavier Gomez-Olive 5 ; RyanWagner 5 ; Estelle Piwowar-Manning 6 ; Kathleen Kahn 5 1 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2 SCHARP, Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA; 3 Univ of Washington, Seattle, WA, USA; 4 Univ of New England, Armidale, Australia; 5 Med Rsr Council/Wits Rural PH and Health Transition Unit, Johannesburg, South Africa; 6 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA Background: Despite the high HIV risk faced by young women in Sub-Saharan Africa, there is limited data examining factors associated with HIV incidence in this population, something that is necessary for effective prevention programming. Methods: HPTN 068 was a phase III individually randomized trial to assess the impact of a conditional cash transfer on the acquisition of HIV among young South African women. The intervention was conducted from April 2011 to March 2015. Participants enrolled in the study were aged 13-20, in high school, not married or pregnant, and resident in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) site, in rural Mpumalanga. Participants were seen at baseline, then annually for up to three follow-up visits, where HIV and HSV-2 testing were conducted and an interview was completed using Audio Computer Assisted Self Interviewing (ACASI). Participants were tested for HIV infection using two HIV rapid tests with Western blot confirmation. The proportional hazards regression model with time varying explanatory variable was used to examine the effect of specified exposures on HIV incidence (SAS version 9.4). Results: 2328 HIV negative young women at baseline who had at least one follow up visit comprised the main analytic sample. 107 incident HIV infections were identified during the study resulting in an incidence of 1.8%. After adjusting for age at baseline, attending school <80% of school days/month, having a male partner who was 5 or more years older, and engaging in transactional sex were significantly associated with HIV incidence (See Table 1). Permanent school drop out and reporting more than one sex partner in the past 12 months were marginally significant with regard to increased risk of HIV acquisition. Experiencing intimate partner violence, unprotected sex in the past 3 months and becoming pregnant in the past 12 months were not associated with HIV incidence.

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CROI 2016